hi
Has anyone had a parathyroid blood test?
My appointment is 8.25am, so should I follow the usual fasting and Levo 24 hours before routine?
Do I stop/ reduce D3/K2?
currently on 4000iu drops.
I’ve read it makes sense to get calcium and vit D tested at the same time. Anyone know if this is routine or if I need to request or if it doesn’t matter?
The reason for testing is cysts found on ultrasound.
TIA 🦋💚🦋
I think you’d have to check if vitamin D has been specifically requested otherwise it’s likely not being tested.
Same with calcium (usually bone in bone profile)
If your thyroid function is being tested delay dose otherwise take levo as normal.
I think the advice is not to take vitamin D before the day of a vitamin D test, doubt it would impact PTH if in doubt delay it.
PTH isn’t tested often, usually it’s requested after 2 abnormal calcium tests. Test has to be processed quickly by lab.
PurpleNails' "processed quickly" point is important.
A lot of samples do not get tested in time - and that can happen even if the blood draw is next door to the analysis lab. Let alone if the draw is being done in, say, a GP clinic.
Thanks both, I can bike the sample to the lab in minutes so I’ll remember to offer.
Much appreciated, 🦋💚🦋
What happens if there's a delay in processing the sample?
Parathyroid hormone has a very short half-life - around five minutes.
It doesn't entirely disappear but breaks up.
Effectively, the longer it takes, the less chance of detecting high PTH. Or being sure someone has low PTH, for that matter.
cripes I’m quite fast on my bike and the surgery is only a few 100 yards from the hospital labs but 5 minutes half life assuming labs can look at it immediately !! Medichecks does a postal one - how on Earth does that work?
They can still manage to do a test - I think some labs say half an hour so long as the sample is put on ice immediately.
But other forms of the test are somewhat more resilient to time and not being kept cold.
Medichecks pth test isn’t postal, you have to go to the clinic.
I’ve had many pth tests as I had hyperparathyroidism, my surgery was about 40 mins drive (collected by lab driver doing the rounds of local surgeries) from the lab and I’ve never had a problem with getting accurate results. You should get calcium, phosphate and VitD tested at the same time but likely only done if you’ve previously had a high calcium result.
I’ve never had calcium tested nor any symptoms related to parathyroid. GP just concerned about proximity of cysts on thyroid ultrasound. Ruling things out I think. 🤷🏽♀️
It’s good they are being thorough.
I was told I didn’t need PTH and I had 1 over range calcium & lowest value in range of phosphate. Doctors repeated test & on subsequent test the calcium was very top of range & phosphate under but as I hadn’t had 2 abnormal in a row they said everything ok.
I have large hyper thyroid nodule & inflamed salivary gland which later settled. Ive had lots of scan but just told - no connection - no action required & no investigation of cause.
Hi purple nails💓
Same here my results in April 2020 2 calciums of 2.63, 2.67 GP never bothered telling me they were over range I found them in my thyroid printouts..he sent them to the endo they did tests in June 2020..PTH 8.1..range..1.60..6.90)
.. cal. 2.51..range..2.10..2.60)
Aug 2020..PTH..9.5
..cal..2.54
Both these tests indicated normocalcaemic hyperparathyroidism where the calcium is top end but in normal range in the face of an over range PTH..
And still my last 2 my PTH was 6.6 with top end calcium and PTH 6 with top end calcium, I have all the symptoms but the endo won't do anything but just let me suffer..well I've had to take this into my own hands now my son as paid for me to see a private parathyroid surgeon in Oxford this Friday 🙏
my GP rang to reassure me that within 24 hours is fine. Me biking the sample to the lab will suffice 😊. She double checked with a biochemist at the labs. They put it on ice while testing but it doesn’t need to be on ice in transit.
Glad you checked.
Correct helvella it has a very short window for testing, although my surgery failed many times to recognise this saying it could spend all day at my surgery and it would be ok for testing🤦 also it was not done in the EDTA tube , they did the same thing with my ionised calcium test leaving it at the surgery all day when it as to be tested within one hour, they made me do the test 3 times because the labs kept sending notes saying it was to degraded to test🤷
why is parathyroid being tested
Suspected hypo or hyper parathyroid?
As I understood it …if testing parathyroid it’s important to test vitamin D and calcium at same time
All things Parathyroid discussed here
And parathyroid app
Thanks, GP says parathyroid hormone is being tested to rule out any neighbouring gland abnormalities linked to the thyroid cysts identified on my ultrasound. A proximity concern. 🤷🏽♀️
Test should be done at a hospital that has path lab attached so can process immediately
I will sort that, thanks for the advice. They clearly have no idea what they are doing.
it’s a rare test for a GP to organise
I had it done for suspected hypo parathyroid
(much rarer than hyper parathyroid)
Turned out it was propranolol lowering PTH
(I finally worked it out)
labtestsonline.org.uk/tests...
Drugs that may decrease PTH include cimetidine and propranolol.
Also get IONIZED calcium tested if a problem with the parathyroids is suspected. When blood is drawn do not attach the elastic strap too tightly, it can influence the result. And yes PTH should be tested in a hospital (the tube on ice). I have hyperparathyrodism (2nd time, no localisation of the adenoma, difficult to operate after 2 previous ops, one for parathyroid adenoma, one for papillary-follicular thyroid cancer). Vit D (1,25) is often too high with hyperparathyroid, but is not usually tested. Vit D 25 is tested more often and should be with PTH, as should the calcium level.
The half-life of PTH is 5 minutes, so, not only are there specific coloured vials to use for that, and the calcium which should be tested in a separate vial from the same draw, but the PTH sample should be immediately iced. This is why many endos prefer this type of testing to be done at a hospital clinic rather than a GP one. Please ensure that the phlebotomist follows the protocol otherwise the lab will not test for PTH.
Thanks for this, I’ll circle back to the surgery and share this info. You’ve saved a lot of wasted time and resources. Much appreciated. 🦋💚🦋
I hope it will prove useful information. Also, I seem to remember that it is unlike a thyroid test in that an early morning test does not show an accurate PTH level. I think around midday is best. Anyway, good luck with the test, and hope it proves a useful diagnostic tool.
This is a little extra from one lab:
PTH has a marked diurnal rhythm with a nadir at 10-11am. If hyperparathyroidism is suspected, we suggest that samples are taken in the mid-morning. Raised levels of PTH in the setting of hypercalcaemia are indicative of primary or tertiary hyperparathyroidism. Symptoms of hyperparathyroidism include “bones” (increased turnover), “groans” (abdominal) and “stones” (renal). Note familial hypocalciuric hypercalcaemia (FHH) can cause diagnostic problems, as PTH may also be raised in this disorder. The two conditions can be differentiated by measuring calcium in a 24 hour urine sample. A normal or unmeasurable PTH in a patient with hypocalcaemia is suggestive of hypoparathyroidism.
leedsth.nhs.uk/a-z-of-servi...
Advice from labs varies. Some certainly require ice, some say freeze. Some labs say sample needs to be centrifuged (in a cooled centrifuge) as soon as possible then frozen.
I suggest you try to find the Pathology Laboratory Handbook for your lab! Maybe ring the lab.
Avoid biotin for at least a day before the test. (Though other tests might need a longer gap.)
A confusing mess of a reply which is why twitter is an awful place to quote from, but, in this specific case, possibly worth it:
Stofskiftesygdom
@Stofskiftesygdo
·
21h
onlinelibrary.wiley.com/doi...
"substantial differences in the endocrine hormone profile were found despite established disease-modifying therapies."
onlinelibrary.wiley.com
Endocrine hormone imbalance in heart failure with reduced ejection fraction: A cross‐sectional study
Background and Aims Sustained neurohormonal activation plays a central role in the progression of heart failure (HF). Other endocrine axes may also be affected. It was the aim of this study to...
Improve Thyroid Treatment Retweeted
Johannes W. Dietrich 🕊️🇺🇦🕊️
@drjwdietrich
Replying to
@Stofskiftesygdo
Interestingly, illness/stress is associated with elevated parathyroid hormone (#PTH) concentrations. This may explain our previous observation of #hyperparathyroidism in complex regional pain syndrome (#CRPS). pubmed.ncbi.nlm.nih.gov/307...
twitter.com/drjwdietrich/st...
thanks for this, have followed both and read the papers. Fascinating 💚
I had hyperparathyroidism with two parathyroid tumors removed in 2014. Prior to my diagnosis I had lab test PTH, ionized calcium, calcium and vitamin D checked. I was told not to take calcium and vitamin D before lab tests. When I did have the tumors removed they also removed a thyroid nodule I had which was benign and also confirmed Hashimoto's. Good luck to you.
Thanks for sharing, this is interesting to read. Also useful information about stopping calcium and D before the tests. How long before the tests were you advised? It’s 2 weeks until my appointment. I don’t take calcium but do take D3 with K2.
I don't remember. But this link below has a lot of useful information about parathyroid.parathyroid.com/
This is where I went to have my surgery done.
Take your thyroid meds as usual but you should stop D a few days before test and calcium if you take it.
PTH, calcium and D must be taken from same blood draw and it will go to lab asap. That is why you have a morning appointment.
I had to become rather an expert as my OH had hyperparathyroid diagnosed early last year and one gland was later removed.
They intially offered me a 12.25 appointment. They were just booking first available they didn’t have a clue. I automatically ask for a earliest out of habit. Hope your OH is ok. Thanks for the info 💚
I live in the united states and have a borderline hyperparathyroid problem. I am on the border, but my dexa scan for my bones showed I just crossed the border into osteoporosis. My doc wants me to take meds for this.......his first choice was prolia (denusaub) but it costs 30,000 dollars a year. But the little parathyroid (4 of them) is so tricky that they activated themselves and thought they would suck out calcium from my bones. The prolia is never to be stopped. If it is stoped the glands just suck out the calcium from the bones at a super speed and you end up worse. I was taking supplementary calcium and D but since I stopped at doctor's request, I feel better. Hyperparathoidism is a tricky problem. I take 50 mg of synthroid and only one multivitamin now. I have no real answer except to caution on the "so called wonder drugs" for osteoporosis..............regards MB in the US
I am so sorry to hear about this, so shocked by the cost of the medication. Have you looked into the clinic in Tampa that others recommend? May work out cheaper in the long term. I read that they don’t recommend the medication. Im very new to all this and appreciate your message. 🦋💚🦋
Yes, there is a parathroid clinic in florida that it very quick.....but most importlantly they can located the ones that are acting up............and remove on the spot. Thank you.....
Hi 💓
The normal way to get parathyroid hormone tested is along with calcium and vitamin D,in the same draw and it should be done in a EDTA tube some surgery's don't follow this.. my surgery didn't follow this as they used an old vitamin D from the previous year, this is not correct and unless the endo or doctor states that these bloods are to test for primary hyperparathyroidism the labs may not do vitamin D, it all depends on whether your vitamin D as been done in the last year.
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